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Building a digital-first healthcare ecosystem

Global healthcare is rapidly changing with the infusion of technology. COVID-19 has significantly accelerated virtual health adoption; virtual visits rose from 19% in the beginning of 2020 to 28% in April 2020. Additionally, consumers are now more comfortable sharing personal data through digital health channels. 

Healthcare players such as doctors, nurses and physiotherapists who fall under the Healthcare Providers (HCPs) group, and hospitals, clinics, and diagnostic laboratories that come under the Health Service Providers (HSPs) group have been actively trying to ensure higher quality of healthcare by leveraging technology.

The pandemic ruthlessly exposed the healthcare industry’s inherent complexity. And, thanks to social distancing becoming the new norm, healthcare leaders were suddenly grappling with how to provide people effective healthcare with minimal or no contact. 

On the other hand, patients were figuring out how to avail critical healthcare without physical interactions. It’s no wonder, technology-led approaches were perhaps the only option for the industry to deliver capable healthcare. 

The future of healthcare will be heavily dependent on the convergence of multiple technologies that will suit the varying requirements of different (healthcare) stakeholders - HSPs, HCPs, patients etc.

For instance, here is a visualization of India’s National Digital Health Blueprint (NDHB) that includes key features like a unified architecture, avenues for privacy and consent control, national portability, electronic health records, appropriate principles and guidelines, and health analytics.

India’s National Digital Health Blueprint (NDHB) that includes key features like a unified architecture, avenues for privacy and consent control, national portability, electronic health records, appropriate principles and guidelines, and health analytics.

This blog shares recommendations on how such robust digital healthcare systems can be established to evolve and better serve patient needs. 

Principles of digital healthcare

The enlisted guiding principles will help nurture any digital healthcare ecosystem, while also bringing players together for a larger purpose i.e. health and wellness for all.  

Put the patient at the center - Traditionally, healthcare has been provider-centric. Almost all technology is meant to help providers in administering healthcare i.e. running the operations of a clinic or a hospital. 

The focus should now shift to being patient-centric, starting from when a patient thinks about availing healthcare to when they are cured. Healthcare stakeholders must channel efforts to serve patients and work backwards, ensuring required improvements are met by the healthcare ecosystem. 

Make health data accountable - Enormous data is generated by a healthcare ecosystem, yet not much of the data is processed to benefit the ecosystem. 

We believe it's imperative for patients to easily access their digitized health records irrespective of the setting (low or high-tech) they are in. Additionally, healthcare leaders should focus on leveraging data to facilitate early detection and prevention of ailments.  

Build and share knowledge - Timely availability and accessibility of clinical knowledge is critical to delivering effective healthcare. HCPs have been collaboratively enriching themselves with clinical knowledge via research, conferences and training. In a digital ecosystem, accessibility plays a critical role, where players not only contribute but also collaborate to enrich clinical knowledge.   

Leverage emerging tech - The appetite to experiment with emerging technology is high in an ecosystem. Different partners in such a setup can provide technology, offer use cases and infrastructure to run a pilot. 

A digital healthcare ecosystem must endeavour to make emerging technologies mainstream. For instance, virtual reality can be used to train HCPs, IoTs (werables, sensors) can be used to monitor patient vitals, and AI and ML can be used for drug development. Or ‘voice to text’ alongside video conferencing could help a doctor focus on patient care rather than spend valuable time updating medical records in an Electronic Medical Record (EMR) system. 

Building blocks of a digital healthcare ecosystem

We recommend focusing on four foundational blocks when building the recommended healthcare ecosystem. They will enable both public organizations and private entities to deliver value across the board.

Deep customer insights - Digital healthcare players should be aware of their customers’ spoken and unspoken needs. A typical digital healthcare ecosystem will generate and store data - patient's medical history, body vitals, drugs dosage details, etc. 

By leveraging this repository of information, HCPs can provide better healthcare, and in some cases even save human lives. For instance, helping patients adhere to a care plan or nudging them to take up annual medical checkups at a special price or even recommending alternative treatment plans.

Domain capabilities - Specializations help players stay relevant in a digital ecosystem. For instance, there are famous experts in specific fields like eye care or heart ailments and cancer care. People travel from all over the country and world to avail their services. When such specialization is compounded with technological expertise - ecosystem players can offer quality care at lesser costs. 

Strategic partnerships - A typical challenge for patients is interfacing with multiple stakeholders in the course of their care. Strategic partnerships enable players to offer a single window service. It thus enables a patient to obtain comprehensive healthcare -  all the way from diagnostics to post hospital care and rehabilitation.

Emerging technologies - Digital technologies, not limited to but including APIs, cloud, IoT, AI, Robotic Process Automation (RPA) and good user experience help create a comprehensive experience for the patient. They also help unify the three building blocks mentioned above.

With the adoption of mobile and connected healthcare devices such as wearables and sensors, technology’s ability to assist healthcare delivery has increased significantly. As an example, remote home care was extensively successful during COVID-19 and ensured only critical patients were treated in ICUs. This reduces the load on hospital infrastructure. 

The 4 A’s of digital healthcare ecosystem

The recommendations shared above, are a paradigm shift from the way healthcare has conventionally been delivered. Such a shift makes significant advancements in four critical areas. We call them the 4A’s of digital healthcare:

Accessibility - With the point of healthcare shifting from a clinic/hospital to a mobile/tablet, anybody with a connected device can access quality healthcare from anywhere, and is no longer constrained to locally available resources. 

Affordability - Initial trends suggest increased adoption of digital will significantly bring down the cost of healthcare. A general practitioner who needs a basic setup (at home or otherwise) to deliver healthcare can do so now from anywhere, with a mobile device. A smart pricing strategy could accelerate affordability. Entry, and switching costs to a digital setup would be kept at zero or minimal.  

Availability - Being digital enables 24/7 availability. It allows patients to make informed choices as they have a list of available services to choose from. It also allows patients to seamlessly cross over between physical and digital environments.  

Acceptability - Acceptability is a challenge for non digital native patients. The mental satisfaction associated with human interactions, especially in the healthcare space, is very difficult to replicate in a digital setup. However, the pandemic has fast tracked acceptability more from compulsion. With constant advancements in technology, acceptability will continue to increase in the new normal. 

India’s digital healthcare ecosystem - The National Digital Health Mission

Our observation is India’s National Digital Health Mission (NDHM) is leveraging the guiding principles that we have described in this blog. In their creation of a digital infrastructure for the country’s progressive health ecosystem, NDHM is implementing several digital forward initiatives:

Identification - Individuals can use a health ID and a digital health locker will store and enable access to a patient’s medical history in a safe and secured manner.

Citizen in control - NDHM is implementing the principles of Data Empowerment and Protection Architecture (DEPA) through the consent manager, privacy operations center and anonymizer.

Omnichannel service delivery - Digital technologies allow for patient information to be accessible to both the patient and health care provider through a channel of choice - health portals or apps, call centers or even social media platforms.

Interoperability - Interoperability allows for all players in the ecosystem to share and consume information. This strengthens the healthcare value chain, by giving the patient a comprehensive health and wellness solution.

We believe digital healthcare will not only fix existing hurdles in the healthcare system but will also call for the (much needed) reengineering of key areas like data security and privacy. Advancements in regulatory compliance, robust fallback systems when tech can’t deliver will accelerate adoption within low-tech populations. 

And we believe, not unlike with digital payments, if initial apprehensions are addressed in a timely manner - adoption of digital tech will not just improve but become inevitable for the healthcare space. 

A version of this article was published in eHealth magazine.

Disclaimer: The statements and opinions expressed in this article are those of the author(s) and do not necessarily reflect the positions of Thoughtworks.

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